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. 2022 Jan 3;9(1):1.
doi: 10.1186/s40479-021-00172-8.

Suicidal ideation, self-injury, aggressive behavior and substance use during intensive trauma-focused treatment with exposure-based components in adolescent and young adult PTSD patients

Anne Fischer  1 , Rita Rosner  2 , Babette Renneberg  3 , Regina Steil  4
Affiliations

Suicidal ideation, self-injury, aggressive behavior and substance use during intensive trauma-focused treatment with exposure-based components in adolescent and young adult PTSD patients

Anne Fischer et al. Borderline Personal Disord Emot Dysregul. .

Abstract

Background: Multiple traumata such as child sexual and/or physical abuse often result in complex psychopathologies and a range of associated dysfunctional behaviors. Although evidence-based interventions exist, some therapists are concerned that trauma-focused psychotherapy with exposure-based elements may lead to the deterioration of associated dysfunctional behaviors in adolescents and young adults. Therefore, we examined the course of suicidal ideation, self-injury, aggressive behavior and substance use in a group of abuse-related posttraumatic stress disorder (PTSD) patients during phase-based, trauma-focused PTSD treatment.

Methods: Daily assessments from a randomized controlled trial (RCT) of Developmentally adapted Cognitive Processing Therapy (D-CPT) were analyzed to test for differences in the stated dysfunctional behaviors between the four treatment phases. We conducted multilevel modeling and repeated measure ANOVAs.

Results: We did not find any significant differences between the treatment phases concerning the stated dysfunctional behaviors, either at the level of urge or at the level of actual actions. On the contrary, in some primary outcomes (self-injury, aggressive behavior), as well as secondary outcomes (distress caused by trauma, joy), we observed significant improvements.

Discussion: Overall, during D-CPT, adolescents and young adults showed no deterioration in dysfunctional behaviors, while even showing improvements in some, suggesting that trauma-focused treatment preceded by skills building was not deleterious to this population. Hence, the dissemination of effective interventions such as D-CPT should be fostered, whilst the concerns of the therapists regarding exposure-based components need to be addressed during appropriate training. Nevertheless, further studies with momentary assessment, extended measurement methods, a control group and larger sample sizes are needed to confirm our preliminary findings.

Trial registration: The trial was registered at the German Clinical Trial Registry (GCTR), DRKS00004787, 18 March 2013, https://www.drks.de/DRKS00004787 .

Keywords: Adolescents; Aggression; Child abuse; Daily diary; Exposure; Self-injury; Substance use; Suicidality.

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Conflict of interest statement

Regina Steil was paid fees for workshops and speeches on PTSD treatment. Rita Rosner was paid fees for workshops and presentations on PTSD treatment. Rita Rosner also coauthored a book on CPT.

Figures

Fig. 1
Fig. 1
Course of the fixed effects from multilevel modeling for suicidal ideation, self-injury, aggressive behavior and substance use (urge) during D-CPT treatment phases. Scores range from 0 to 5 with higher scores indicating a greater urge to engage in the dysfunctional behaviors. Error bars represent the standard errors of the estimates
See this image and copyright information in PMC

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